| NPI | 1548896319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AK 225178) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: VA 0101273156) |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2025-09-23 |